The name scleroderma adultorum is given to a rare form of skin disease which affects considerable areas and is usually symmetrical. Morphoea or Addison's keloid has similar anatomical characters, but occurs in localized patches.

In the more diffuse form of scleroderma proper, extensive tracts of skin are sometimes involved, such as the greater part of the face, the arms, etc. In a case observed by the author, the face, chest, and both forearms and hands were affected, and dry gangrene had occurred in the fingers, which had a stiff black appearance.

The nature of these affections is not quite determined, but many facts point to a nervous origin. There is the symmetrical character of the lesion and its wide distribution, as well as the fact that lesions of the sympathetic have been believed to give rise to it. The lesions, consisting of a slow increase of the connective tissue with atrophy of the special structures, resemble those which occur in muscles as a result of severance from their trophic centres.

In its anatomical details the skin in both forms presents characters which may be summarized as atrophy with chronic inflammation. The papillae are mostly flattened, and the cutis thinner than normal; the cutis is composed also of more homogeneous connective tissue than usual, having somewhat the characters of cicatricial tissue, and less fibrous than that of the normal skin. This condition extends somewhat to the subcutaneous tissue where the fat is to a considerable extent atrophied, apparently by the encroachment of the connective tissue.

The hairs are also atrophied in the affected areas, and there is said to be alopecia when the patches extend to the hairy scalp. The evidence of chronic inflammation is the existence of abundant nuclei in the altered skin. These are usually aggregated around the blood-vessels, but they are also seen around sebaceous glands and under the rete Malpighii. Complete recovery seems to be not uncommon in this disease, although it may be slow.

Allied to scleroderma in the general characters of the lesion in the skin is the condition commonly designated Sclerema neonatorum. In this disease the skin, usually of the lower extremities, is hard and swollen, so that movement of the limbs is curtailed. When it persists for some time the skin may be like parchment.


Herpes - Picaud, Des eruptions cutan. consec. aux lesions traumat. 1875; Mitchell, Injuries of nerves, etc., 1872; Barensprung, Charite-Annalen, ix., 1863; Kaposi, Hautkrankh., 1882; Charcot, Dis. of nerv. syst., i. (Syd. Soc), 1877. Glossy skin - Paget, Med. Times and Gazette, i., 1864; Mitchell, 1. c.; Bowlby, Injuries and Dis. of nerves, 1889. Scleroderma - Hilton Fagge, Guy's Hosp. Bep., 1867, xv., 187; Chiari und Mader, Vierteljahrschr. f. Dermat. u. Syph., 1878; Hutchinson, Lect. on clin. surg., 1878; Schwimmer, Die neuropath. Dermatosen, 1883; M'Calman, Glasg. Med. Jour., xvi., 1881; Steven, ibid., xxvi., 1886; Erben, Vierteljahrsch. f. Dermat., xv., 1888; Lewin and Heller, (literature very full) Charite-Annalen, xix., 1894; Ballantyne, (Sclerema) Brit. Med. Jour., 1890, i., 403. Addison's Keloid - Addison, Published writings (Syd. Soc), 1869; Hilton Fagge, 1. c.; Hutchinson, 1.